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A COMPARISON OF HAEMATOLOGY ANALYSERS. A thesis presented in partial fulfilment (30%) of the requirements for the degree of Master of Veterinary Science at Massey University Fiona Joy Sharp 1996
ABSTRACT There has been a rapid development in haematology analysers over the last decade. As a result, veterinarians in clinical practice are faced with a number of options when it comes to laboratory services. Choices include using an in-clinic analyser, making use of government and private veterinary diagnostic laboratories, or private medical and hospital laboratories. Fundamental problems exist with using animal blood on analysers designed for human blood. Erythrocytes from some animals are much smaller than those of humans and may be confused with platelets. Furthermore there are species differences with regards to both total white cell count and the proportions of the different leucocytes. In this study a widely used veterinary haematology analyser (ABX Minos Vet) was compared with two medical analysers (Technicon Hl and the Coulter VCS) using blood from cats and dogs with normal and abnormal haemograms. Also included in the comparison were the Automated and Manual QBC-V analysers which are being marketed to Veterinarians for in-clinic use. The values obtained by all analysers were in close agreement when estimating the packed cell volume of both cats and dogs. Total white cell counts in dogs were also relatively consistent across all analysers, but in cats there was considerable variation in estimates of total white cell count between analysers and when compared with manual estimation using a haemocytometer. This variation highlights the difficulty in obtaining accurate total white cell counts in cats, probably due to interference by clumping of platelets. Platelet counts obtained by the ABX Minos Vet in dogs correlated well with those counts obtained by both medical analysers but not with the QBC-V analysers. In cats, there was poor correlation of platelet counts between all analysers thus emphasising the problems caused by platelet clumping in this species. The total platelet counts in cats, and to a lesser extent in dogs, 11
should not therefore be interpreted rigidly and should be checked by visual appraisal of blood smears. Measurements obtained by the Automated QBC-V most closely correlated with those of the ABX Minos Vet rather than with the Manual QBC-V, suggesting that it is capable of providing more accurate results. A further study was carried out to determine the effects of time on blood parameters as, in a normal clinical setting there can be considerable variation in the time elapsing between collection of the blood sample and its analysis. Blood from five cats and five dogs was tested on the three specially adapted veterinary haematology analysers (both QBC-V models and the ABX Minos Vet), over a 24 hour period. The packed cell volumes in both dogs and cats remained consistent over this time period. The platelet counts in four of the five cats dropped into the thrombocytopenic range at either two or four hours post collection, on all of the analysers. This coincided with a peak in the white cell count observed on the ABX Minos Vet. It is likely that aggregated platelets were being recognised as white cells by the ABX Minos Vet. These results suggest that measurement of the total platelets and white cell counts in cats at two and four hours after blood collection may be less reliable than measurements made either immediately after collection or later than four hours. In dogs, the total platelet counts and white cell counts were relatively consistent over the 24 hour period and any variation encountered would not have altered the interpretation of the results. lll
ACKNOWLEDGEMENTS. Many thanks are due to Dr Keith Thompson who encouraged me to persevere with this project, showed amazing patience and was a great support throughout it. Thanks also to Professor Colin Wilks for allowing me to undertake this study in the Department of Veterinary Pathology and Public Health, and to Associate Professor Boyd Jones and Dr Grant Guilford for allowing me access to their clinical cases. Gratitude is due to the staff of the Clinical Pathology Lab, at Massey University. In particular to Roz Power who helped me in the tedious task of entering data and encouraged me throughout the numerous manual differentials and white cell counts, Sheryl Bayliss for rescuing me from numerous computer glitches and Jenni Donald who helped with the finer points of thesis writing. Thanks to fellow post-graduate John Mundy for his warped sense of humour and generosity in sharing the limited computer facilities. Thanks also to Peter Wildbore for liaising with the haematology companies for me. Recognition needs to go to Frazer Allan who helped greatly with my statistics and is responsible for the production of the graphs in chapter three. Special thanks to Eric Kells and Steve Johnson for allowing me to use their haematology analysers at the Palmerston North Hospital and the private medical laboratory in Palmerston North respectively. IV
Thanks to Associate Professor Michael Tartellin for allowing me to include some of the cats from the feline nutrition unit in my study. The completion of this thesis would not have been possible without the support of my family who assisted me financially and in so many other ways over the last two years. Finally to Vincent, for always being there. V
TABLE OF CONTENTS Title Abstract 11 Acknowledgements IV Table of Contents VI List of Figures Vlll I. General Introduction 1 II. Review of Haematology Analysers 4 2.0 Introduction 4 2. 1 QBC-V Analyser 4 2.2 Coulter VCS Analyser 9 2. 3 T echnicon H 1 Analyser 12 2.4 ABX Minos Vet Analyser 17 Ill. Comparative Study of Haematology Analysers 19 3. 1 Introduction 19 3.2 Materials and Methods 19 3.2. 1 Animals Used 19 3.2.2 Specimen Collection 19 3.2.3 Haematology Analysers 20 3.2.4 Materials and Methods 20 3. 2. 5 Statistical Analysis 21 3.3 Results 22 3.3.1 PCV's in dogs and cats 22 3.3.2 WCC's in dogs and cats 27 VI
3. 3. 3 Platelet counts in dogs and cats 31 3.3.4 Comparison of Differential WCC's 34 3.3.5 Comparison of QBC-V Analysers 34 3.4 Discussion 36 3. 5 Conclusions 40 IV Time Course Study 42 4.1 Introduction 42 4.2 Materials and Methods 42 4.3 Results 43 4.3.1 Cats-PCV's 43 Platelet counts 45 WCC's 48 4.3.2 Dogs-PCV's 51 Platelet counts 53 WCC's 55 4.4 Discussion 57 4.5 Conclusions 59 V. Summary and Conclusions 60 VI. References 63 vii
LIST OF FIGURES Figure 1 Page6 Quantitative buffy coat analysis tube of canine blood, copied from Levine et al (1986):Quantative buffy coat analysis of blood collected from dogs, cats and horses. Journal of the American Veterinary Medical Association 189: 670-673. Figure 2 Page8 Automated QBC-V analyser read out, copied from Knoll et al ( 1996): In-clinic analysis, quality control, reference values, and system selection. Veterinary Clinics of North America 2615: 981-1 003. Figure 3 Page 11 Electrical impedence cell counting, copied from Corash and Handin et al (1 995): Blood; Principles and Practice ofhematology pp 23-59. Figure 4 Page 11 Hydrodynamic focusing, copied from Corash and Handin et al (1995): Blood; Principles and Practice ofhematology pp 23-59. Figure 5 Page 13 Coulter VCS display, copied from Corash and Handin et al (1 995): Blood; Principles and Practice ofhematology pp 23-59. Figure 6 Page 16 Platelet Histogram, copied from Simson et al (1 995): Atlas of automated cytochemical hematology, Bayer Office Copy. Figure 7 Page 16 Results and histogram display results from the Technicon Hl, copied from Corash and Handin et al ( 1995): Blood; Principles and Practice ofhematology pp 23-59. Figure 8 Page 22 Scattergram and line of best fit for the ABX Minos Vet versus the Coulter VCS for packed cell volumes in dogs. Figure 9 Page 23 Scattergram and line of best fit for the ABX Minos Vet versus the Automated QBC-V for packed cell volumes in dogs. Figure 10 Page 24 Scattergram and line of best fit for the ABX Minos Vet versus the Technicon H 1 for packed cell volume in cats. Figure 11 Page 25 Scattergram and line of best fit for the ABX Minos V et versus the Manual QBC-V for packed cell volumes in cats. Figure 12 Page 26 Scattergram and line of best fit for the Automated QBC-V versus the Manual QBC-V for packed cell volumes in cats. Figure 13 Page 27 Scattergram and line of best fit for the ABX Minos Vet versus the Coulter VCS for white cell counts in dogs. viii
Figure 14 Page 28 Scattergram and line of best fit for the ABX Minos Vet versus the Manual QBC-V for white cell counts in cats. Figure 15 Page 28 Scattergram and line of best fit for the Manual QBC-V versus the Automated QBC-V for white cell counts in dogs. Figure 16 Page 29 Scattergram and line of best fit for the ABX Minos Vet versus the Manual QBC-V for white cell counts in cats. Figure 17 Page 30 Scattergram and line of best fit for the ABX Minos Vet versus the manual white cell count in cats. Figure 18 Page 31 Scattergram and line of best fit for the ABX Minos Vet versus the Technicon HI for platelet counts in dogs. Figure 19 Page 31 Scattergram and line of best fit for the ABX Minos Vet versus the Automated QBC-V for platelet counts in dogs. Figure 20 Page 32 Scattergram and line of best fit for the ABX Minos Vet versus the Coulter VCS for platelet counts in cats. Figure 21 Page 33 Scattergram and line of best fit for the Manual versus the Automated QBC-V for platelet counts in cats. Figure 22 Page 44 Line graph for the Manual QBC-V versus time for packed cell volumes in cats. Figure 23 Page 44 Line graph for the Automated QBC-V versus time for packed cell volumes in cats. Figure 24 Page 45 Line graph for the ABX Minos vet versus time for packed cell volumes in cats. Figure 25 Page 46 Line graph for the Manual QBC-V versus time for platelet counts in cats. Figure 26 Page 47 Line graph for the Automated QBC-V versus time for platelet counts in cats. Figure 27 Page 47 Line graph for the ABX Minos Vet versus time for platelet counts in cats. Figure 28 Page 48 Line graph for the Manual QBC-V versus time for white cell counts in cats. Figure 29 Page 49 Line graph for the Automated QBC-V versus time for white cell counts in cats. IX
Figure 30 Page 50 Figure 31 Page 51 Line graph for the ABX Minos V et versus time for white cell counts in cats. Line graph for the Manual QBC-V versus time for packed cell volumes in dogs. Figure 32 Page 52 Line graph for the Automated QBC-V versus time for packed cell volumes in dogs. Figure 33 Page 52 Line graph for the ABX minos Vet versus time for packed cell volumes in dogs. Figure 34 Page 53 Line graph for the Manual QBC-V versus time for platelet counts in dogs. Figure 35 Page 54 Line graph for the Automated QBC-V versus time for platelet counts in dogs. Figure 36 Page 55 Line graph for the ABX Minos Vet versus time for platelet counts in dogs. Figure 37 Page 56 Line graph for the Manual QBC-V versus time for white cell counts in dogs. Figure 38 Page 56 Line graph for the Automated QBC-V versus time for white cell counts in dogs. Figure 39 Page 57 Line graph for the ABX Minos Vet versus time for white cell counts in dogs. X